Study challenges beliefs on menopause estrogen, body fat

ORLANDO -- It turns out middle-aged women are more mysterious than researchers expected.

Some common assumptions about when menopausal symptoms start, who gets them and why are all challenged by new findings from a large national study and some smaller regional ones, University of Pittsburgh psychologist Karen Matthews says. She presented her findings at a weekend meeting of the American Psychosomatic Society.

Hot flashes have been traditionally linked to a loss of estrogen, but women with the lowest levels of estrogen actually don't suffer more from hot flashes. And contrary to conventional wisdom, women with the most body fat, which converts into a form of estrogen, do have trouble with flashes, Matthews says. Instead, race, ethnicity and economic class trump estrogen in predicting hot flashes:

* Women who sometimes or often have trouble making ends meet report worse problems with hot flashes than more affluent women.

* Black women have the most flashes; Asians and Hispanics have the least. Whites fall in between.

* More estrogen or body fat doesn't protect against flashes. White and Hispanic women have the highest estrogen levels; Asians and blacks have the lowest. Asian women tend to be slim and have the fewest flashes, and black women are heavier and have the most.

These differences surfaced in the Study of Women's Health Across the Nation (SWAN), a large, ongoing study of midlife women. SWAN is following 3,200 women from before menopause into their 50s.

''Frankly, we don't understand why race or ethnicity would be important'' in the flashes, says Matthews, a SWAN researcher. Stress, culture, exercise and weight might play roles, she adds.

SWAN and other studies also reveal that estrogen levels don't drop in a straight shot after perimenopause starts, Matthews says. During perimenopause, a time of irregular periods that can last four years or more, estrogen takes a roller-coaster ride. Some forms of estrogen climb higher than levels typical for women age 25 to 35, which can cause heavy bleeding. Sleep problems and forgetfulness can be worse at this time, she says.

And scientists can't explain why some women start flashes even before they're in perimenopause.

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